The relationship between socioeconomic level and gluten-free diet compliance in celiac patients

A lifelong gluten-free diet forms the current treatment for celiac disease. The most important indicator for the prognosis of the disease is compliance with the diet. Individuals with low socioeconomic status may have lower rates of both gluten-free diet compliance and access to food and care. This is an important relationship that needs to be evaluated. In this study, we aimed to evaluate the effect of socioeconomic level on gluten-free diet compliance. We interviewed face-to-face with celiac patients who were followed up in Adıyaman University Hospital Gastroenterology Polyclinic, who came to the polyclinic control and who had a diagnosis of disease for at least one year during the interview. In our study, routinely examined nutritional parameters, celiac autoantibodies, AST, ALT, ALP, GGT, Albumin, and hemogram parameters were evaluated in order to evaluate the dietary compliance of the patients. It was aimed to compare these parameters with the survey data showing the socioeconomic level of the patients, such as income status, education level, occupation, number of people in the family, etc. In order to investigate the effect of the socioeconomic level of the patients on gluten-free diet adherence, we prepared a questionnaire showing the socioeconomic level and applied it to patients with a diagnosis of celiac disease for at least one year, as a face-to-face interview. In celiac patients, a period of at least 6 months is required for the autoantibody to become negative. We included patients who were at least one year after diagnosis. Data such as age and gender obtained in our study are compatible with general literature knowledge. In order to evaluate the dietary compliance of the participants, it was accepted that the patients with positive t-TG IgA results did not comply with the diet and the patients with negative t-TG IgA results were considered to be compatible with the diet. In addition, other autoantibodies were also evaluated. In addition, patients with negative autoantibodies evaluated were considered compliant with the diet, and patients with positive any of the tested antibodies were considered to be incompatible with the diet, and another grouping was made. In our study, when dietary compliance was evaluated according to the t-TG IgA result, no significant difference could be found between the age at diagnosis and adherence to gluten-free diet (p:0.336). However, when dietary compliance was evaluated according to any antibody positivity and all antibodies being negative, a significant difference was observed (p:0.007). It was observed that the age of diagnosis was lower in the participants whose all antibodies were negative. When dietary compliance was evaluated according to the t-TG IgA results of the participants, a significant difference was found between the time passed after diagnosis and gluten-free diet compliance (p:0.011). Likewise, it was found to be significant when dietary compliance was evaluated according to any antibody positivity and all antibodies being negative (p:0.016). In our study, a significant relationship was observed between folic acid deficiency and dietary compliance, and it was shown that the folic acid level of the participants who adhered to the diet was significantly higher (p:0.003). In addition, a significant relationship was found between Ast(p:0.007), Alt(p:0.039) and Alp (p:0.020) levels and diet compliance, and it was shown that these parameters were significantly lower in celiac patients who adhered to the diet. In our study, the participants were grouped according to their monthly income. However, no significant results were found on dietary compliance (p:0.372). However, in our study, although there was no statistically significant result between income status and diet compliance, it was seen that as the income level increased, the dietary compliance of the participants was proportionally higher. This shows us that more studies with longer follow-up and more participants are needed to fully understand the effect of socioeconomic status on gluten-free diet adherence. In addition, the work we have done; shows that individuals with low socioeconomic status may have lower rates of both gluten-free diet compliance and access to food and care. This is an important relationship that needs to be evaluated. Because new strategies can be developed to improve gluten-free diet adherence by focusing on the difficulties of patients with low socioeconomic status and by directing resources as necessary. Keywords: Celiac, Gluten-free diet, Socioeconomic Level